Provider Demographics
NPI:1508605916
Name:CORNETT, KATELYN (OTR/L)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:CORNETT
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 POPE ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TN
Mailing Address - Zip Code:37303-2574
Mailing Address - Country:US
Mailing Address - Phone:423-453-6525
Mailing Address - Fax:
Practice Address - Street 1:65 MOUSE CREEK RD NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-4840
Practice Address - Country:US
Practice Address - Phone:423-476-7212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-23
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7819225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist